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Abstract

Background: Increasingly, policies and payment structures are holding health care systems accountable for the health of their population, refocusing attention on community attributes that influence health. However, the complex and contextual aspects of a community make it challenging to know which community attributes may affect the health risk of individuals.

Methods: We investigated the relationship of CVD prevalence and risk factors with a novel index of well-being, the Gallup-Healthways Well-being Index (GHWBI, 2010), consisting of 55 survey responses organized into 6 domains: life evaluation (LE); emotional health (EH); work environment (WE); physical health (PH); healthy behaviors (HB); and basic access [to food, shelter, and health care] (BA). Individuals >18y were randomly selected for telephone survey (n=348,846). Overall index and domain scores were made available to us aggregated to the Congressional District (CD) level. Prevalence of heart disease, stroke, hypertension, and diabetes, as well as CV health (absence of these factors), were determined using the 2011 Behavioral Risk Factor Surveillance System (BRFSS) sub-group study (224 counties). We linked datasets by assigning average BRFSS item responses at the county level to county zip codes; we then re-aggregated to CD and weighted by zip code. We used weighted linear regression to assess: (1) rates of CVD/CV health across GHWBI quintiles, and (2) independent effects of the 6 GHWBI domains on CVD/CV health, reported as t-scores. Because the PH domain included survey items related to CVD, we repeated this analysis excluding PH as an independent variable.

Results: Higher CD well-being scores (n=316 CDs) were associated with lower prevalence of CVD and higher rates of CV health (Table). Independent effects of the GHWBI domains revealed inverse associations between CVD and HB, and heart disease and LE. CV health was positively associated with EH and BA, but negatively associated with HB. Excluding PH from this analysis did not meaningfully affect the results.

Discussion: Population well-being is associated with reduced CVD and improved CV health, even at the CD level. Future research should investigate these relationships within smaller more homogeneous community populations, in order to identify targets for intervention.